Now that you’ve read part 2….(you have read parts 1 and 2 right?)
We need to shift the focus of the blame game from the individual. We can’t continue waiting to see what individuals will do, we need to steer them. And a nudge is not sufficient, people need a push (the Government seems to prefer a gentler and cheaper and less controversial nudge)! We need political commitment, collaboration of public and private stakeholders (governments, international partners, civil society and nongovernmental organizations and the private sector). Undoubtedly, all these play major roles in shaping healthy environments and making healthier diet options affordable and easily accessible. It is undeniable that changes by the food industry could accelerate health gains worldwide. In what way? Reducing fat, sugar and salt content of processed foods and portion sizes, introducing innovative, healthy, and nutritious choices, and reviewing current marketing practices.
An interesting read in this matter comes from a series of papers looking at “Lessons from Tobacco Control for the Obesity Control Movement”. Tobacco and obesity? Think about it. “Both public health problems share common elements of “false consciousness” (“smoking/obesity is simply the result of the consumers’ free choices”) and a powerful industry whose interests are best served if consumers smoke/overeat.”. What we need is a shift away from individual risk factors to the creation of an atmosphere conducive to health (as opposed to an environment that promotes obesity – “obesogenic” environment or smoking).
But how do you do that? Governments may need to implement radical policy change, to regulate food consumption and control food industry in a similar way to that of tobacco industry, by banning advertising of selected produce, taxing certain foods, and rationing purchase/restricting availability of certain types of food or opportunities to eat (in particular, foods targeted to children). Side by side to this, we obviously also need to provide information about how to avoid over-eating, increase concern about the adverse effects of over-eating, provide treatment for over-eating, and reducing the social acceptability of over-eating or eating too much of particular kinds of food.
But how can a Government, any Government, justify this? McCormick et al (2007) attempts to provide a rationale for government intervention. It proposes four drivers of Government intervention: externalities (the individual does not bear the full costs of obesity, society does, e.g. NHS), imperfect information (“If individuals do not fully understand or accurately perceive the risks and consequences of their choices regarding diet, exercise and weight, they may make decisions that do not maximize their welfare”), vulnerable individuals (there is clear unquestionable evidence that patterns of food consumption and exercise are set early in life – this puts in a strong case for government intervention in preventing childhood obesity) and time-inconsistent preferences (“a situation in which an individual’s preferences change over time without any change in information; for instance, intending to drink only three pints at the pub but drinking more when you get there”).
However, draconian action of this kind would be considered disproportionate and politically unacceptable. Some of the most intrusive options available will only really become an option “if observable patterns of over-eating come to be viewed by the public as illegitimate, thus meriting tough action to control them”. This means that most politicians would consider such actions as potential political suicide (particularly as in the space of a 5 year Parliament it may be difficult to see the benefits of such interventions…and thus re-election). Talks of an attack on free choice and nanny state would certainly follow. Imagine the outburst of the daily newspapers….And then food is not tobacco. We need food but we clearly don’t need tobacco. This just makes the problem even more complex. Then again, what was the situation with tobacco 40 years ago? How much have we changed? In the developed world, we’ve reduced smoking prevalence by almost half through taxation of tobacco products, smoking bans in public places, laws prohibiting tobacco sales to minors, advertising restrictions, and aggressive public education campaigns. “Public health interventions to decrease obesity prevalence must apply the same kind of multifaceted and coordinated approach that reduced tobacco use in order to change individual behavior patterns and effectively address the environmental barriers to physical activity and healthful food choices.”
What do the years ahead look like? The October 2007 Foresight report, Tackling Obesities: Future Choices project predicted that 60% of men, 50% of women and 25% of children could be obese by 2050 and that the overall costs to society could climb up to 40-50 billion (depending on which statistician is right) by 2050 if nothing changed between now and then. This compares to the current estimate of 16 billion (NHS direct costs and other costs to society and the economy (e.g. sickness absence reduces productivity)). Can the NHS budget resist such an aggression? Can we afford to spend 16 billion pounds every year (and increasing) on treating obesity and its consequences? Are we not going through a financial crisis? Who is going to pay for consecutive Governments’ failures to choose and enforce the most cost-effective measures to save us from this “obesogenic” environment? Yes, you’ve guessed it. Tax payers…